Provider Demographics
NPI:1336535863
Name:ROSALISE PHARMACY CORP
Entity Type:Organization
Organization Name:ROSALISE PHARMACY CORP
Other - Org Name:ROSALISE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-690-6502
Mailing Address - Street 1:3355 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-7402
Mailing Address - Country:US
Mailing Address - Phone:212-690-6502
Mailing Address - Fax:646-838-6985
Practice Address - Street 1:3355 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7402
Practice Address - Country:US
Practice Address - Phone:212-690-6502
Practice Address - Fax:646-838-6985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0334803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033480OtherNYS PHARMACY LICENSE